Within the South African provinces, the Cape has a reputation for "Stab" wounds, and these wound profiles are often seen in the ER. One such admission to the Christiaan Barnard Memorial Hospital Trauma and Emergency Centre was a young man who recently suffered a stab wound to the abdomen whilst enjoying the evening at a local night club in the City. Statistically, the more common objects used to inflict a stab wound include:

Anatomy:

The abdomen may be divided into 4 quadrants but it is important to note that any abdominal wound may also involve organs of the chest, pelvis or structures behind the peritoneal cavity such as the duodenum, kidneys or aorta

The amount of damage caused by the injury is dependent on the area affected and the underlying organs and vessels, and the depth of the stab wound, with the most common site being that of the left-upper quadrant.

Classification: Abdomen injuries are classified by the type of structure that is damaged and how the injury occurred. The types of structures include the:

Abdominal wall

Solid organs (liver, spleen, pancreas, or kidneys)

Hollow organs (stomach, small intestine, colon, ureters, or bladder)

Blood vessels

Abdominal injuries may also be further classified by whether the injury is:

Blunt, or

Penetrating

In the case of a penetrating injury, an object breaks the skin. Some penetrating injuries involve only the fat and muscles under the skin. This type of injuries is much less concerning than those that enter the abdominal cavity. Stab wounds that enter the abdominal cavity do not always result in damage of underlying organs or blood vessels. Sometimes, a penetrating injuries can involve both the chest and the upper part of the abdomen. For example a
downward stab wound to the lower chest may go through the diaphragm into the stomach, spleen, or liver.

Complications:

In addition to the immediate damage, abdominal injuries may also cause problems later on. These delayed problems include

Hematoma rupture

Intra-abdominal collection of pus (abscess)

Intestine blockage (obstruction)

Abdominal compartment syndrome

In many people, stab wounds may be obvious with evidence of blood. Occasionally, they are not so obvious and one has to rely on the events that occurred to determine the type of injury sustained. Smaller weapons such as bicycle spokes that have been sharpened leave little to no evidence of a stab wound, and can cause critical underlying injures.

Patients with an obvious stab wound to the abdomen may be taken directly to the operating room for exploratory surgery and do not undergo diagnostic tests to identify the specific injuries. However, most people with an abdominal injury require diagnostic testing which identifies the specific injury and, combined with the findings on the physical examination, helps doctors decide which patients require surgical intervention.

The main diagnostic tools used to explore penetrating stab wounds include:

Ultrasonography

Computed Tomography (CT)

Ultrasonography can be done quickly at the person's bedside, and is useful for finding severe bleeding. CT takes a little longer and requires moving the person to the scanner but gives more precise images. CT may also be able to detect other related injuries such as fractures.

Depending on the type of injury, x-rays of the chest or pelvis may also be needed. The ER may also perform a urinalysis to detect blood in the urine, which indicates damage to some part of the urinary system. Usually a complete blood count is done so doctors have initial information to compare should the person need further treatment.